Basic Information
Provider Information | |||||||||
NPI: | 1205887056 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ANDERSON | ||||||||
FirstName: | CHRISTOPHER | ||||||||
MiddleName: | GEORGE | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 12410 EAST SINTO | ||||||||
Address2: | SUITE 201 | ||||||||
City: | SPOKANE | ||||||||
State: | WA | ||||||||
PostalCode: | 99216 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5099284334 | ||||||||
FaxNumber: | 5099287893 | ||||||||
Practice Location | |||||||||
Address1: | 12410 EAST SINTO | ||||||||
Address2: | SUITE 210 | ||||||||
City: | SPOKANE | ||||||||
State: | WA | ||||||||
PostalCode: | 99216 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5099284334 | ||||||||
FaxNumber: | 5099287893 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/15/2006 | ||||||||
LastUpdateDate: | 08/08/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | MD00046103 | WA | Y |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
ID | Type | State | Issuer | Description | 0155873 | 05 | MT |   | MEDICAID | 3131AN | 01 |   | ASURIS | OTHER | P00346484 | 01 |   | RR MEDICARE | OTHER | 0206858 | 01 | WA | DEPT OF LABOR & INDUSTRIE | OTHER | 3131AN | 01 |   | ASURIS NW HEALTH | OTHER | 807413200 | 05 | ID |   | MEDICAID | G8860150 | 01 | WA | MEDICARE WA | OTHER | 8449464 | 05 | WA |   | MEDICAID |